Webendobj 3 0 obj /Contents 6 0 R /Group 7 0 R /MediaBox [ 0 0 612 792 ] /Parent 1 0 R /Resources /ColorSpace 8 0 R /ExtGState 10 0 R /Font 13 0 R /ProcSet [ /PDF ... WebDEPARTMENT OF HEALTH & HUMAN SERVICES Types of Verification All Programs Use documents, collateral contacts or home calls to verify informa-tion. A document is a …

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Webinformation must be provided on a DHS form, the form is enclosed. You must get the proofs to me or call me by the due date below. If you do not, your benefits may be denied or cancelled. ... DHS-3688. Shelter verification Current proof of rent, mortgage or land contract payments Property tax and insurance bills on your home for past year WebOct 2, 2024 · Also see 0010.18.01 (Mandatory Verifications - Cash Assistance) for additional MFIP provisions relating to citizenship and immigration status. If no other form of verification is available or if the client chooses to use a form to verify residence or shelter expenses, you may use the Authorization for Release of Information About Residence … first source bank bluffton indiana

Human services e-forms Hennepin County

WebCD 357 — Request For Waiver of Child Care Facility Regulation. CY 142 — Child Care Employee Data Sheet. CY 321 — Day Care Agreement. CY 862 — Medication Log. CY 863 — Verbal Request for Release of Child. CY 864 — Fire Drill Log. CY 866 — Incident Report Form. CY 867 — Emergency Contact/Parental Consent Form. WebESG subgrantees are required to document homeless or at-risk status as part of the intake process for participants. Eligibility and documentation requirements are set forth by the … WebHuman services e-forms. Below is a list of frequently requested Human services forms. Click on the form to complete and print. Learn how to submit documents. Absent parent statement. Application for payment of long-term care services. Authorization to obtain or release information/records. Change report form. campari underwriting